{SITE HOME} {RENAL HOME} {THE REVIEWS}
Please feel free to save this form for filling in at your leisure.
Unit Name:
Hospital Name:
Contact Address: Put the Unit's address here! eg: Crappy Haemodialysis Unit Anytown Anyplace 123 ABC
Contact Phone & Fax:
Main or Satellite Unit? Main Satellite
Machine Type:
Dialysate: Bicarbonate Acetate
Building/Environment Details: For Example you may like to comment on some of the points listed below. Modern Portakabin Access: Decor: General Cleanliness: Ventilation: Parking:
Size of Unit:
Patient Facilities:
Patient Support:
What it's like to Dialysis there?: Is it a pain or a pleasure?;-)>
Additional Comments!: Feel Free!
Your Name:
Your Contact Email: